Provider Demographics
NPI:1073215513
Name:ZUBRICKI, AMANDA (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZUBRICKI
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 BANKS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8287
Mailing Address - Country:US
Mailing Address - Phone:609-617-3340
Mailing Address - Fax:
Practice Address - Street 1:1621 BANKS VIEW DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-8287
Practice Address - Country:US
Practice Address - Phone:609-617-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13105124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist